Finotab

Indications

Finerenone is used in adults with chronic kidney disease linked to type 2 diabetes, where the urine contains protein (albumin). It slows the decline of kidney function and lowers the risk of heart problems such as heart attack, heart failure and death from heart disease. In some countries it is also approved for certain types of heart failure. It is used alongside usual diabetes and blood pressure treatment.

How It Works

Finerenone blocks the mineralocorticoid receptor, which is over-activated in diabetic kidney disease and drives inflammation and scarring (fibrosis) in the kidneys and heart. Blocking it protects these organs. It is a non-steroidal medicine, so it has fewer hormone-related side effects than older medicines of this type.

Dosage and Administration

As prescribed. The usual dose is 10 mg or 20 mg once a day, chosen according to kidney function (eGFR) and blood potassium. The doctor checks potassium and kidney function before starting, about 4 weeks after starting or changing the dose, and regularly after that, and adjusts or pauses the dose if potassium rises. Take at the same time each day, with or without food. Tablets may be crushed and mixed with water or soft food if swallowing is difficult.

Interactions

• Must not be used with strong CYP3A4 inhibitors such as Ketoconazole, Itraconazole, Clarithromycin or Ritonavir, which greatly raise its levels.
• Avoid strong or moderate CYP3A4 inducers such as Rifampicin, Carbamazepine, Phenytoin and St John's wort, which make it work less well. Avoid grapefruit and grapefruit juice.
• Medicines that raise potassium, such as potassium supplements, potassium-sparing diuretics (Spironolactone, Eplerenone, Amiloride), ACE inhibitors, ARBs and Trimethoprim, increase the risk of high potassium. Many people take an ACE inhibitor or ARB with it under close monitoring.
• Moderate CYP3A4 inhibitors such as Erythromycin, Verapamil and Fluconazole need extra potassium checks.

Contraindications

• Use of strong CYP3A4 inhibitors.
• Addison's disease (adrenal insufficiency).
• Allergy to Finerenone or any ingredient.
• Starting treatment is not advised if blood potassium is already high (above 5.0 mmol/L).

Side Effects

The most common side effect is high blood potassium (hyperkalaemia). Others include low blood pressure, dizziness, low blood sodium, itching, and a small, usually temporary fall in kidney function (eGFR) after starting.

Get urgent medical help for: muscle weakness or heaviness, an irregular, very slow or pounding heartbeat, chest pain, fainting, or severe dizziness, as these may be signs of dangerously high potassium or very low blood pressure.

Pregnancy and Lactation

Animal studies suggest possible harm to the baby; it should not be used in pregnancy unless the doctor decides it is clearly necessary, and women who could become pregnant should use effective contraception. Do not breastfeed while taking it.

Precautions and Warnings

• Regular blood tests for potassium and kidney function are essential.
• Do not use potassium supplements or salt substitutes containing potassium unless the doctor advises.
• Not recommended in severe liver impairment; tell the doctor about any liver disease.
• Tell the doctor if you have vomiting, diarrhoea or are not drinking well, as dehydration can raise potassium and affect the kidneys.

Overdose

Too much is most likely to cause high potassium and low blood pressure. Seek medical help promptly; a blood test and heart tracing (ECG) may be needed.

Therapeutic Class

Non-steroidal mineralocorticoid receptor antagonist (kidney and heart protective agent).

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.